Revision TKR Third and final surgery all done

[sistersinhim]

t does seem that recently the Mayo Clinic has taken a different approach to PT. We had a member last winter who had her TKR done there and she had no formal PT.

The Mayo Clinic does order no PT after a tkr. That's why you couldn't find any exercises for it.

 

[kayow11]

Thanks CELLE, JOCKETTE, and Fire Wolf for your response to my particular questions. I do know that the wedge needs to be a certain way and not cause pain or pressure on the calf or the hamstring.
And as far as the drugs go, I just like to hear what other people have done or taken per their doctors instruction. I do see my surgeon for a follow up a week from this coming Friday and was going to mention tramadol to him. Have no idea if it is helpful or not. I guess when you're taking oxycodone, nothing else really seems to have much impact. I don't want to take any more ibuprofen though. So thanks for your thoughts and ideas. I will talk to my surgeon about it when I see him.

 

[Jockette]

@sistersinhim is there a link for the info that the Mayo Clinic does not order PT? I have looked but couldn't find that info. I would love to be able to prove it to family and friends who don't believe me when I tell them that.

 

[kayow11]

When I do see my surgeon in about 10 days, I am going to mention the mayo clinic way of doing things after a replacement of the knee. See what he says. I will be curious .

 

[sistersinhim]

I looked online, too, and I couldn't find any reference to the no formal PT. But, I searched our threads here and have found some with personal experience with the Mayo Clinic:

I will tag @KarriB so she can give you more information. I believe she's away right now, but will soon get back on.

Anytime there is a change in protocol it takes a while for all parties to get on board. This is what's happening with TKR recovery. A friend had TKR surgery at Mayo Clinic and was prescribed no PT whatsoever and her ROM is great.

This lady had hers done at Mayo and did no formal PT.

I had mine done at Mayo Clinic and they no longer believe in the pushing of it. They give you the exercises to do at home and tell you they want the knee to rest and heal. Do what you are comfortable with.you will get there in baby steps.

There's more than these, but these are the more current ones.

 

[Jockette]

@sistersinhim Thank you, that is good enough for me personally!! But if you ever do find something "official" I would love to have it. I know, and you know, the Bonesmart ways works and is good, but most people I know do not agree, even those who've had tkr. They swear by PT and "doing your exercises". I've given up discussing it with them.

Thanks again!

 

[sistersinhim]

How much more 'official' can you get than personal experience? Anyway, I've ask for help on this. It might take a while, but we'll find it.

 

[OJ2]

As far as meds, my surgeon had me on oxy, tramadol, and Tylenol, along with a nausea med, and daily doses of aspirin, and meloxicam. At 4 weeks I was off everything except the Tylenol. Weaned off the oxy. But stopped the Tramadol quickly because hubby didn't notice I was running low, and I ran out. Don't recommend that. I could have asked for more, but it would have required a 30 min trip into the city to pick up the rx.

 

[sistersinhim]

When people bugged me about doing my exercises, at first I tried to explain what my experience taught me and they just looked at me like I was crazy. Then, I decided to just give up and smile and nod my head and add a 'phew' with it! I really was doing my exercises by using my knee everyday the way it was supposed to be used! Maybe you can try what I did and just agree with them. There's no fighting people that have a one-set mind. We know what works, and they don't want to hear it!

Here's an article I found online: https://sbfphc.wordpress.com/2013/0...hysical-therapy-after-total-knee-replacement/

 

[Josephine]

That's in the Library, Paula TKR: Ceasing aggressive physical therapy after surgery

And I did the same as you - just nodded and smiled! However, I did 'fess' up to my surgeon at my 6 week review in 2015. He was okay about it and delighted!

 

[KarriB]

It sounds like one of our "recovered in 2 weeks and back to work stories", but...my mother's bff had her TKR (her son drove her from eastern Ohio to the Mayo Clinic because she wasn't letting anyone else do it but Mayo) at Mayo Clinic 3 years ago and did NO PT at all. Never had a script for it, just stretches and heel slides they showed her at the hospital and walking. At the time I was unaware of BS and their philosophy, so I thought they were being easy on her because of her age (late 70s at the time). But it seems that's their philosophy. My OS did his fellowship at Mayo so when its time for my LTKR that's the card I'm pulling.

 

[Josephine]

my mother's bff

@KarriB - what's a bff?

 

[alexthecat]

bff is Best Friend Forever

Sent from my Z799VL using Tapatalk

 

[kayow11]

Hello Bonesmart friends, it is day 10 for me and I have not done one exercise except today I tried to do five heel slides and five quad Sets and a little knee extension stretch. A couple of them hurt a little so I backed off and just iced afterwards.

I just have to ask this question, did any of you go through two or three months of lots of rest ice and elevation, no exercise, and then kept going like that for months and not gain back a functional range of motion? I just have that fear that doing nothing except resting and some walking along with could backfire on me.

Is there anyone out there that hasn't shared their lack of progress by doing things the bone smart way?

 

[kayow11]

OK friends, I was a bit hasty sending that note just a few minutes ago before reading what you guys had written in the last couple days. I did call Mayo clinic yesterday and asked to talk to someone in physical therapy. They said the PT supervisor would call me but he didn't on Friday so I will call him again on Monday morning.

Would just like to get some thoughts and ideas on what they are doing these days post TKR if he will level with me. I will update you all once he calls me back. My biggest fear is not bending because when you can hardly bend at all, there is so much function that is not available to you. And you feel like you are stumbling around with bionic parts that aren't coordinated well.

I also have an aunt who had both of her knees done and when I saw her a few months ago she said she never got The bend back in one of her knees. This was a few years ago. And I watched how she walks and moves around and it isn't good.

I don't like being fearful and doubting like this, and you guys have all posted wonderful stories personally and of others, but I also don't like the idea of being super painful from doing the exercises either. I guess I just have to take a chance and try it without exercising hardly at all since I know What exercise does with my first knee.

 

[KarriB]

BoneSmart doesn't say not to bend your knee, it says not to participate in aggressive physical therapy such as PTs pushing/pulling on knees, weights before month 4, etc. Take a look at the Activity progression for TKRs and you'll see there's activity listed there, especially after weeks 4-6, as it's important to let the knee heal from surgery.

I'm not sure if I mentioned this in your thread, but I was in an immbolizer for a month with NO bending. Not a heel slide or a stretch and very little walking which was done with a peg leg. After that month my OS prescribed non-aggressive therapy. I asked what that meant, he slid my foot with his foot about 2 inches and told me to begin bending while walking. That was all I did for 2 weeks and then I went to PT with more non-aggressive therapy which included; rocking pedals on a bike (because I couldn't get a full rotation), heel slides, ham string stretches, and stepping over mini-hurdles about 3-4 inches off the ground. I got a full rotation on the bike about 4 weeks after I began bending again and continued to bike with 0 resistance every day for short stints.

I went from about 35 to 109 when I was dismissed from PT at 5 months post op, then I continued to gain ROM a year or more later. At 18 months I realized one day that I was squatting in the water. Now I had pain when walking or standing too long until recently when I began walking intentionally. The walking, I believe, helped to build up muscles around my knee which lessened the pain. My PTs even did strength training with me at 4-5 months, but walking is what did the trick for me, so I do wish I had walked more earlier. But now walking is no problem for my RTKR. In fact today I walked over 4 miles and my TKR doesn't hurt at all and even standing after the 4 miles wasn't painful at all.

There are quite a few who did no PT at all, such as @sistersinhim and of course Josephine. Then there are those who set the ground rules for their PT like @SusieShoes.

 

[liam2015]

hi kawow11 ~ to answer your question of "going through 2 or 3 months of lots of rest, ice and elevation, no exercise......." ~ i did no exercises for the first 6 weeks (other than the very simple ones you do in bed that the hospital recommends for the first 10 days) because i was so nauseous from the percocets which i quit at 3 weeks and took 2 more weeks to feel better and eat again. i did do household chores such as emptying the dishwasher, helping prepare meals and cleaning up after, feeding the dog, etc. but i did not have physio come to my house and i did not go to the prescribed physio therapy until 6 weeks post op when i was recommended a physiotherapist clinic which i pay for privately.

yes, my recovery is slow in some areas (r.o.m.) but great in other areas (walking, no pain when walking, no limping, conquering stairs alternate feet, walking a big dog, walking up and down hills, etc. my flexion is very close to 100 degrees and my extension around 6 degrees at 5 months post op and i'm noticing improvement every one or two weeks. i still cannot pedal a full rotation on bike. i actually didn't even properly elevate until around 7 weeks when i got my lounge doctor.

i understand how you feel, wondering what is the right way to recovery. my surgeon was furious with me for not going to physio earlier than 6 weeks and he kept after me to schedule a m.u.a. which i kept refusing (due to my own reasons, not wanting to feel the pain again or take pain meds and also didn't want to depend on hubby and others again if i could help it) and tried to get him to understand that i was improving gradually. eventually he told me that he contacted his colleagues where he trained and they agreed that i could gain r.o.m. as long as i continued to improve. prior to this, my surgeon said i would be stuck at 80 degrees and nothing would help me to improve because i wouldn't be able to stand the necessary pain involved from pushing further. i hope i taught him something ~ he is quite young but very experienced and highly rated.

i hope you get the answers from mayo clinic.

 

[kayow11]

Thanks Liam and KarriB for your response to my concerns. All of you guys help me to think more clearly without getting so caught up in a fear trap. I feel I am being pushed from every direction to do PT, do PT, do PT and make sure you do your exercises at home too. Or else! I also have to do certain requirements in case I ended up applying for long-term disability from my work if I can't do my job by mid December.

I guess the next best thing for me in these next few weeks is to get as much ammo as I can in regards to the newer idea of less aggressive PT for maximum healing and recovery.

Thank you all so much for your information and personal stories of success despite extra problems.

On a different note, did any of you find that tramadol was particularly helpful for you with pain relief?

I know one or two haven't responded to this question before but just would like some more opinions about it. Would like to get off oxycodone sooner if I can find something else to help me. Right now I think I will need to stay on oxycodone for at least a couple more weeks though. Just too fresh and painful to let go of that narcotic right now.

 

[liam2015]

Several members here have had good success with going to PT but they make sure to insist on respect from them that they will not be aggressive to the point of hurting you.

I have only had treatments done at my PT (no exercise) with handouts of home exercises that I choose to do. I hurt myself doing a balancing exercise, setting me back 2 weeks with pain so I stopped doing that one. My physiotherapist said that was the right thing to do.

She does massage, sometimes cupping, recently acupuncture, laser treatment and tens machine, along with measuring doing some manipulation. It can be helpful and even feel good/healing. I love the massage and tens machine. Then they put ice packs below and on top of my knee, cover me up and turn down the lights, soft radio station playing and I relax for 20 minutes.

I see you're only 10 days post op ~ up to you whether you feel up to going out for PT just now.

Too soon to stop the oxycodone as you mentioned. I don't know about Tramadol, but I've read here that it is helpful to some and not so with others. Maximum dose of Tylenol is also recommended for pain after weaning off narcotics. I'll let the medical people advise you on that.

 

[Celle]

I just have to ask this question, did any of you go through two or three months of lots of rest ice and elevation, no exercise, and then kept going like that for months and not gain back a functional range of motion? I just have that fear that doing nothing except resting and some walking along with could backfire on me.
Is there anyone out there that hasn't shared their lack of progress by doing things the bone smart way?

I don't like being fearful and doubting like this, and you guys have all posted wonderful stories personally and of others, but I also don't like the idea of being super painful from doing the exercises either. I guess I just have to take a chance and try it without exercising hardly at all since I know What exercise does with my first knee.

@kayow11 - you sound very fearful and anxious about this second TKR. Has something in particular happened that has got you so concerned?

Don't give up on your first TKR. There is still plenty of time for its ROM to increase, and I fully believe that it will.

On BoneSmart, we never recommend lying round, doing nothing at all. We advise you to get up and walk around the house for about 5 minutes every hour or so. We consistently say that your knee gets all the exercise it needs, just from your normal activities of daily living - which you slowly increase, as your recovery progresses.
Gentle PT is OK too, as long as you have a therapist who does not recommend aggressive or over-active therapy. A good PT, who tailors your exercise to your knee's needs, is worth keeping.

We recommend no pushing or pulling on your knee, and nothing that causes pain, at the time or later.

We also recommend plenty of rest, ice and elevation, so your knee has a chance to heal, and to encourage the swelling to go down, because it's swelling that keeps your knee stiff and slows down its ability to bend.

Yes, you overdid the PT with your first TKR, but the slow-down of its progress is not irreversible. That knee could still end up with a good ROM.

On a different note, did any of you find that tramadol was particularly helpful for you with pain relief
I know one or two haven't responded to this question before but just would like some more opinions about it. Would like to get off Oxycodone sooner if I can find something else to help me. Right now I think I will need to stay on Oxycodone for at least a couple more weeks though. Just too fresh and painful to let go of that narcotic right now.

It's very early days to be thinking about coming off the Oxycodone. There's no harm in continuing to take it while you need it. It's extremely unlikely that you will become addicted.
Myth busting: on getting addicted to pain meds

The time to come off it is when you find you are forgetting to take a dose, and not feeling any increased pain.

My hospital had a rule that my surgeon could not prescribe the heavy-duty narcotics for longer than 2 weeks after my discharge from hospital.
Consequently after those two weeks, I was prescribed Tramadol, which I took in combination with Paracetamol (Tylenol). As long as I took those medications on time, according to the chart that Josephine recommends, they controlled my pain very well.
If you decide it's time to go that route, let us know, and we'll give you Josephine's Tramadol-Tylenol chart.

Each morning, I would write in a little notebook which medications were due, and at what time. As I took each dose, I crossed it off my list. That way, I didn't forget, and I could be sure I didn't accidentally take an extra dose.